Click here to view prescribing information for the hydromorphone product range:
Case 5
A 50-year-old man with head and neck cancer, had severe ear pain due to his tumour. He was started on morphine, but was very sleepy and was therefore switched to oxycodone. His condition improved for several weeks, but when the oxycodone dose was rapidly increased due to severe pain, the problem of sleepiness returned. He was switched to the Palladone® range and, despite receiving a high dose, he was able to communicate effectively with his family before his death.
Case 6
A 70-year-old man with carcinoma of the rectum, was referred to a day hospice with opioid-sensitive severe rectal pain. He was initially treated with 40 mg of morphine 4-hourly. This relieved the pain, but he also experienced nausea and constipation, and occasionally forgot to take his medication. He was switched to fentanyl patches and continued to take 40 mg immediate release morphine for breakthrough pain. However, he often found his analgesia insufficient and an increase in his morphine dose to 60 mg led to unacceptable side effects. Switching him to oxycodone was unsuccessful, so he was given transmucosal fentanyl lozenges and his dose was titrated upwards. At a dose of 1600 μg, his pain relief was better than with morphine, but his pain often returned after 30 – 40 minutes and he would need to use two lozenges in quick succession. Whilst at home, his oral opioids were increased in an effort to combat the problem, but he became unwell and was admitted to the hospice.
As the duration of his breakthrough pain was too long for transmucosal fentanyl, he was started on Palladone® capsules 7.8 mg as required. This gave a more acceptable balance of analgesia and side effects, and he was discharged home with both drugs, allowing him to choose between them depending on the quality and severity of the breakthrough pain he experienced.
Unfortunately, whilst at home, he was switched from Palladone® capsules to morphine. This led to recurrence of his side effects and re-admission to the hospice, where Palladone® capsules were re-instated. The switch back to Palladone® capsules improved his symptoms and, once his condition was stable again, he returned home and continued to use a combination of Palladone® capsules and transmucosal fentanyl.
Case 7
A mother of two in her thirties with oesophageal cancer. Had initially been treated with morphine, but she experienced sedation and hallucinations. Switching to oxycodone solved the problems, but as her cancer became more aggressive and her pain increased, the increased doses of oxycodone led to drowsiness, confusion and hallucinations. In addition to the side effects, She was starting to find swallowing difficult. She was switched to the Palladone® range, which allowed her to open the capsules and sprinkle the contents onto her food. Her side effects subsided and her pain was brought under control. She was able to care for her children and lead a relatively normal life until her death.
NB If patients use the option of opening Palladone® SR capsules and sprinkling the contents onto soft, cold food, they must be instructed not to chew or crush the contents as this will disrupt the prolonged release mechanism and could lead to overdose.
Case 8
A woman in her early fifties with breast cancer, was experiencing severe nociceptive and neuropathic pain with some hand contractures. She was initially treated with morphine, but within three weeks, she became drowsy and confused. She was switched to oxycodone and responded well initially, but within four weeks, she was again experiencing drowsiness, which she found distressing. She was switched to Palladone® SR capsules. After four weeks on a dose of 10 mg 12-hourly, she had excellent pain control with no signs of drowsiness or confusion. She was happy to remain on Palladone® SR capsules and staff commented that her quality of life was improved.
To view case studies 1 to 4, please click here
To view case studies relating to renal failure and opioid switching, please click here